Fingerprint Card
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1
2LEAVE BLANK
TYPE OR PRINT ALL INFORMATION IN BLACK
FBI
LEAVE BLANK
NAM
APPLICANT
LAST NAME
FIRST NAME
MIDDLE NAME
* See Privacy Act Notice on Back
FD-258 (REV.12-10-07)
SIGNATURE OF PERSON FINGERPRINTED
ALIASES
AKA
O
R
I
DOB
DATE OF BIRTH
RESIDENCE OF PERSON FINGERPRINTED
Month
Day
Year
CTZ
CITIZENSHIP
SEX
RACE
HGT.
WGT.
EYES
HAIR
POB
PLACE OF BIRTH
DATE
SIGNATURE OF OFFICIAL TAKING FINGERPRINTS
OCA
YOUR NO.
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EMPLOYER AND ADDRESS
FBI
FBI NO.
CLASS
ARMED FORCES NO.
MNU
REASON FINGERPRINTED
SOCIAL SECURITY NO.
SOC
REF.
MISCELLANEOUS NO.
MNU
1. R. THUMB
2. R. INDEX
3. R. MIDDLE
4. R. RING
5. R. LITTLE
6. L. THUMB
7. L. INDEX
8. L. MIDDLE
9. L. RING
10. L. LITTLE
LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY
L. THUMB
R. THUMB
RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY
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